Provider Demographics
NPI:1922625151
Name:WATSON, JAYDA TRIDINIA
Entity Type:Individual
Prefix:
First Name:JAYDA
Middle Name:TRIDINIA
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MOONRAKER DR APT 301
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4057
Mailing Address - Country:US
Mailing Address - Phone:757-806-0018
Mailing Address - Fax:
Practice Address - Street 1:500 MOONRAKER DR APT 301
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4057
Practice Address - Country:US
Practice Address - Phone:757-806-0018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-04
Last Update Date:2020-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health